|
MESH GORE BIO-A 7*10CM HH0710
|
Facility
|
OP
|
$3,950.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$513.50 |
| Max. Negotiated Rate |
$3,792.00 |
| Rate for Payer: Aetna Commercial |
$3,041.50
|
| Rate for Payer: Anthem Medicaid |
$1,358.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,081.00
|
| Rate for Payer: Cash Price |
$1,975.00
|
| Rate for Payer: Cigna Commercial |
$3,278.50
|
| Rate for Payer: First Health Commercial |
$3,752.50
|
| Rate for Payer: Humana Commercial |
$3,357.50
|
| Rate for Payer: Humana KY Medicaid |
$1,358.40
|
| Rate for Payer: Kentucky WC Medicaid |
$1,372.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,239.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,915.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,185.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,385.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,476.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,962.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$790.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$513.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,224.50
|
| Rate for Payer: PHCS Commercial |
$3,792.00
|
| Rate for Payer: United Healthcare All Payer |
$3,476.00
|
|
|
MESH GORE BIO-A 7*10CM HH0710
|
Facility
|
IP
|
$3,950.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$513.50 |
| Max. Negotiated Rate |
$3,792.00 |
| Rate for Payer: Aetna Commercial |
$3,041.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,081.00
|
| Rate for Payer: Cash Price |
$1,975.00
|
| Rate for Payer: Cigna Commercial |
$3,278.50
|
| Rate for Payer: First Health Commercial |
$3,752.50
|
| Rate for Payer: Humana Commercial |
$3,357.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,239.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,915.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,185.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,476.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,962.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$790.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$513.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,224.50
|
| Rate for Payer: PHCS Commercial |
$3,792.00
|
| Rate for Payer: United Healthcare All Payer |
$3,476.00
|
|
|
MESH PARIETEX PROGRIP 15*15CM
|
Facility
|
OP
|
$4,804.21
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$624.55 |
| Max. Negotiated Rate |
$4,612.04 |
| Rate for Payer: Aetna Commercial |
$3,699.24
|
| Rate for Payer: Anthem Medicaid |
$1,652.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,747.28
|
| Rate for Payer: Cash Price |
$2,402.10
|
| Rate for Payer: Cigna Commercial |
$3,987.49
|
| Rate for Payer: First Health Commercial |
$4,564.00
|
| Rate for Payer: Humana Commercial |
$4,083.58
|
| Rate for Payer: Humana KY Medicaid |
$1,652.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,668.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,939.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,545.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,441.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,685.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,227.70
|
| Rate for Payer: Ohio Health Group HMO |
$3,603.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$960.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$624.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,489.31
|
| Rate for Payer: PHCS Commercial |
$4,612.04
|
| Rate for Payer: United Healthcare All Payer |
$4,227.70
|
|
|
MESH PARIETEX PROGRIP 15*15CM
|
Facility
|
IP
|
$4,804.21
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$624.55 |
| Max. Negotiated Rate |
$4,612.04 |
| Rate for Payer: Aetna Commercial |
$3,699.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,747.28
|
| Rate for Payer: Cash Price |
$2,402.10
|
| Rate for Payer: Cigna Commercial |
$3,987.49
|
| Rate for Payer: First Health Commercial |
$4,564.00
|
| Rate for Payer: Humana Commercial |
$4,083.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,939.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,545.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,441.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,227.70
|
| Rate for Payer: Ohio Health Group HMO |
$3,603.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$960.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$624.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,489.31
|
| Rate for Payer: PHCS Commercial |
$4,612.04
|
| Rate for Payer: United Healthcare All Payer |
$4,227.70
|
|
|
MESH PARIETEX PROGRIP 30*15CM
|
Facility
|
OP
|
$5,478.03
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$712.14 |
| Max. Negotiated Rate |
$5,258.91 |
| Rate for Payer: Aetna Commercial |
$4,218.08
|
| Rate for Payer: Anthem Medicaid |
$1,883.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,272.86
|
| Rate for Payer: Cash Price |
$2,739.01
|
| Rate for Payer: Cigna Commercial |
$4,546.76
|
| Rate for Payer: First Health Commercial |
$5,204.13
|
| Rate for Payer: Humana Commercial |
$4,656.33
|
| Rate for Payer: Humana KY Medicaid |
$1,883.89
|
| Rate for Payer: Kentucky WC Medicaid |
$1,903.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,491.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,042.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,643.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,921.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,820.67
|
| Rate for Payer: Ohio Health Group HMO |
$4,108.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,095.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$712.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,698.19
|
| Rate for Payer: PHCS Commercial |
$5,258.91
|
| Rate for Payer: United Healthcare All Payer |
$4,820.67
|
|
|
MESH PARIETEX PROGRIP 30*15CM
|
Facility
|
IP
|
$5,478.03
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$712.14 |
| Max. Negotiated Rate |
$5,258.91 |
| Rate for Payer: Aetna Commercial |
$4,218.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,272.86
|
| Rate for Payer: Cash Price |
$2,739.01
|
| Rate for Payer: Cigna Commercial |
$4,546.76
|
| Rate for Payer: First Health Commercial |
$5,204.13
|
| Rate for Payer: Humana Commercial |
$4,656.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,491.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,042.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,643.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,820.67
|
| Rate for Payer: Ohio Health Group HMO |
$4,108.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,095.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$712.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,698.19
|
| Rate for Payer: PHCS Commercial |
$5,258.91
|
| Rate for Payer: United Healthcare All Payer |
$4,820.67
|
|
|
MESH PATCH PROCEED VENTRAL MED
|
Facility
|
OP
|
$4,117.62
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$535.29 |
| Max. Negotiated Rate |
$3,952.92 |
| Rate for Payer: Aetna Commercial |
$3,170.57
|
| Rate for Payer: Anthem Medicaid |
$1,416.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,211.74
|
| Rate for Payer: Cash Price |
$2,058.81
|
| Rate for Payer: Cigna Commercial |
$3,417.62
|
| Rate for Payer: First Health Commercial |
$3,911.74
|
| Rate for Payer: Humana Commercial |
$3,499.98
|
| Rate for Payer: Humana KY Medicaid |
$1,416.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,430.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,376.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,038.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,235.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,444.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,623.51
|
| Rate for Payer: Ohio Health Group HMO |
$3,088.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$823.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$535.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,276.46
|
| Rate for Payer: PHCS Commercial |
$3,952.92
|
| Rate for Payer: United Healthcare All Payer |
$3,623.51
|
|
|
MESH PATCH PROCEED VENTRAL MED
|
Facility
|
IP
|
$4,117.62
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$535.29 |
| Max. Negotiated Rate |
$3,952.92 |
| Rate for Payer: Aetna Commercial |
$3,170.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,211.74
|
| Rate for Payer: Cash Price |
$2,058.81
|
| Rate for Payer: Cigna Commercial |
$3,417.62
|
| Rate for Payer: First Health Commercial |
$3,911.74
|
| Rate for Payer: Humana Commercial |
$3,499.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,376.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,038.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,235.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,623.51
|
| Rate for Payer: Ohio Health Group HMO |
$3,088.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$823.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$535.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,276.46
|
| Rate for Payer: PHCS Commercial |
$3,952.92
|
| Rate for Payer: United Healthcare All Payer |
$3,623.51
|
|
|
MESH PATCH PROCEED VENTRAL SM
|
Facility
|
OP
|
$3,803.35
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$494.44 |
| Max. Negotiated Rate |
$3,651.22 |
| Rate for Payer: Aetna Commercial |
$2,928.58
|
| Rate for Payer: Anthem Medicaid |
$1,307.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,966.61
|
| Rate for Payer: Cash Price |
$1,901.67
|
| Rate for Payer: Cigna Commercial |
$3,156.78
|
| Rate for Payer: First Health Commercial |
$3,613.18
|
| Rate for Payer: Humana Commercial |
$3,232.85
|
| Rate for Payer: Humana KY Medicaid |
$1,307.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,321.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,118.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,806.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,141.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,334.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,346.95
|
| Rate for Payer: Ohio Health Group HMO |
$2,852.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$760.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$494.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,179.04
|
| Rate for Payer: PHCS Commercial |
$3,651.22
|
| Rate for Payer: United Healthcare All Payer |
$3,346.95
|
|
|
MESH PATCH PROCEED VENTRAL SM
|
Facility
|
IP
|
$3,803.35
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$494.44 |
| Max. Negotiated Rate |
$3,651.22 |
| Rate for Payer: Aetna Commercial |
$2,928.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,966.61
|
| Rate for Payer: Cash Price |
$1,901.67
|
| Rate for Payer: Cigna Commercial |
$3,156.78
|
| Rate for Payer: First Health Commercial |
$3,613.18
|
| Rate for Payer: Humana Commercial |
$3,232.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,118.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,806.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,141.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,346.95
|
| Rate for Payer: Ohio Health Group HMO |
$2,852.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$760.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$494.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,179.04
|
| Rate for Payer: PHCS Commercial |
$3,651.22
|
| Rate for Payer: United Healthcare All Payer |
$3,346.95
|
|
|
MESH PERFIX PLUGS LG
|
Facility
|
IP
|
$1,864.50
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$242.38 |
| Max. Negotiated Rate |
$1,789.92 |
| Rate for Payer: Aetna Commercial |
$1,435.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,454.31
|
| Rate for Payer: Cash Price |
$932.25
|
| Rate for Payer: Cigna Commercial |
$1,547.54
|
| Rate for Payer: First Health Commercial |
$1,771.28
|
| Rate for Payer: Humana Commercial |
$1,584.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,528.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,376.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$559.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,640.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,398.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$372.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$242.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$578.00
|
| Rate for Payer: PHCS Commercial |
$1,789.92
|
| Rate for Payer: United Healthcare All Payer |
$1,640.76
|
|
|
MESH PERFIX PLUGS LG
|
Facility
|
OP
|
$1,864.50
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$242.38 |
| Max. Negotiated Rate |
$1,789.92 |
| Rate for Payer: Aetna Commercial |
$1,435.66
|
| Rate for Payer: Anthem Medicaid |
$641.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,454.31
|
| Rate for Payer: Cash Price |
$932.25
|
| Rate for Payer: Cigna Commercial |
$1,547.54
|
| Rate for Payer: First Health Commercial |
$1,771.28
|
| Rate for Payer: Humana Commercial |
$1,584.82
|
| Rate for Payer: Humana KY Medicaid |
$641.20
|
| Rate for Payer: Kentucky WC Medicaid |
$647.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,528.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,376.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$559.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$654.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,640.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,398.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$372.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$242.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$578.00
|
| Rate for Payer: PHCS Commercial |
$1,789.92
|
| Rate for Payer: United Healthcare All Payer |
$1,640.76
|
|
|
MESH PERFIX PLUGS MED
|
Facility
|
OP
|
$1,864.50
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$242.38 |
| Max. Negotiated Rate |
$1,789.92 |
| Rate for Payer: Aetna Commercial |
$1,435.66
|
| Rate for Payer: Anthem Medicaid |
$641.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,454.31
|
| Rate for Payer: Cash Price |
$932.25
|
| Rate for Payer: Cigna Commercial |
$1,547.54
|
| Rate for Payer: First Health Commercial |
$1,771.28
|
| Rate for Payer: Humana Commercial |
$1,584.82
|
| Rate for Payer: Humana KY Medicaid |
$641.20
|
| Rate for Payer: Kentucky WC Medicaid |
$647.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,528.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,376.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$559.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$654.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,640.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,398.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$372.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$242.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$578.00
|
| Rate for Payer: PHCS Commercial |
$1,789.92
|
| Rate for Payer: United Healthcare All Payer |
$1,640.76
|
|
|
MESH PERFIX PLUGS MED
|
Facility
|
IP
|
$1,864.50
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$242.38 |
| Max. Negotiated Rate |
$1,789.92 |
| Rate for Payer: Aetna Commercial |
$1,435.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,454.31
|
| Rate for Payer: Cash Price |
$932.25
|
| Rate for Payer: Cigna Commercial |
$1,547.54
|
| Rate for Payer: First Health Commercial |
$1,771.28
|
| Rate for Payer: Humana Commercial |
$1,584.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,528.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,376.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$559.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,640.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,398.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$372.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$242.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$578.00
|
| Rate for Payer: PHCS Commercial |
$1,789.92
|
| Rate for Payer: United Healthcare All Payer |
$1,640.76
|
|
|
MESH PERFIX PLUG X-LG
|
Facility
|
OP
|
$10,739.43
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,396.13 |
| Max. Negotiated Rate |
$10,309.85 |
| Rate for Payer: Aetna Commercial |
$8,269.36
|
| Rate for Payer: Anthem Medicaid |
$3,693.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,376.76
|
| Rate for Payer: Cash Price |
$5,369.72
|
| Rate for Payer: Cigna Commercial |
$8,913.73
|
| Rate for Payer: First Health Commercial |
$10,202.46
|
| Rate for Payer: Humana Commercial |
$9,128.52
|
| Rate for Payer: Humana KY Medicaid |
$3,693.29
|
| Rate for Payer: Kentucky WC Medicaid |
$3,730.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,806.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,925.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,221.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,767.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,450.70
|
| Rate for Payer: Ohio Health Group HMO |
$8,054.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,147.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,396.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,329.22
|
| Rate for Payer: PHCS Commercial |
$10,309.85
|
| Rate for Payer: United Healthcare All Payer |
$9,450.70
|
|
|
MESH PERFIX PLUG X-LG
|
Facility
|
IP
|
$10,739.43
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,396.13 |
| Max. Negotiated Rate |
$10,309.85 |
| Rate for Payer: Aetna Commercial |
$8,269.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,376.76
|
| Rate for Payer: Cash Price |
$5,369.72
|
| Rate for Payer: Cigna Commercial |
$8,913.73
|
| Rate for Payer: First Health Commercial |
$10,202.46
|
| Rate for Payer: Humana Commercial |
$9,128.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,806.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,925.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,221.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,450.70
|
| Rate for Payer: Ohio Health Group HMO |
$8,054.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,147.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,396.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,329.22
|
| Rate for Payer: PHCS Commercial |
$10,309.85
|
| Rate for Payer: United Healthcare All Payer |
$9,450.70
|
|
|
MESH PHASIX 12*12 30*30CM
|
Facility
|
OP
|
$79,332.64
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,313.24 |
| Max. Negotiated Rate |
$76,159.33 |
| Rate for Payer: Aetna Commercial |
$61,086.13
|
| Rate for Payer: Anthem Medicaid |
$27,282.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61,879.46
|
| Rate for Payer: Cash Price |
$39,666.32
|
| Rate for Payer: Cigna Commercial |
$65,846.09
|
| Rate for Payer: First Health Commercial |
$75,366.01
|
| Rate for Payer: Humana Commercial |
$67,432.74
|
| Rate for Payer: Humana KY Medicaid |
$27,282.49
|
| Rate for Payer: Kentucky WC Medicaid |
$27,560.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65,052.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58,547.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,799.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$27,829.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$69,812.72
|
| Rate for Payer: Ohio Health Group HMO |
$59,499.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,866.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,313.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,593.12
|
| Rate for Payer: PHCS Commercial |
$76,159.33
|
| Rate for Payer: United Healthcare All Payer |
$69,812.72
|
|
|
MESH PHASIX 12*12 30*30CM
|
Facility
|
IP
|
$79,332.64
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,313.24 |
| Max. Negotiated Rate |
$76,159.33 |
| Rate for Payer: Aetna Commercial |
$61,086.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61,879.46
|
| Rate for Payer: Cash Price |
$39,666.32
|
| Rate for Payer: Cigna Commercial |
$65,846.09
|
| Rate for Payer: First Health Commercial |
$75,366.01
|
| Rate for Payer: Humana Commercial |
$67,432.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65,052.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58,547.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23,799.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$69,812.72
|
| Rate for Payer: Ohio Health Group HMO |
$59,499.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,866.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,313.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24,593.12
|
| Rate for Payer: PHCS Commercial |
$76,159.33
|
| Rate for Payer: United Healthcare All Payer |
$69,812.72
|
|
|
MESH PHASIX 15*20CM
|
Facility
|
IP
|
$21,279.75
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,766.37 |
| Max. Negotiated Rate |
$20,428.56 |
| Rate for Payer: Aetna Commercial |
$16,385.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,598.20
|
| Rate for Payer: Cash Price |
$10,639.88
|
| Rate for Payer: Cigna Commercial |
$17,662.19
|
| Rate for Payer: First Health Commercial |
$20,215.76
|
| Rate for Payer: Humana Commercial |
$18,087.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,449.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,704.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,383.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,726.18
|
| Rate for Payer: Ohio Health Group HMO |
$15,959.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,255.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,766.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,596.72
|
| Rate for Payer: PHCS Commercial |
$20,428.56
|
| Rate for Payer: United Healthcare All Payer |
$18,726.18
|
|
|
MESH PHASIX 15*20CM
|
Facility
|
OP
|
$21,279.75
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,766.37 |
| Max. Negotiated Rate |
$20,428.56 |
| Rate for Payer: Aetna Commercial |
$16,385.41
|
| Rate for Payer: Anthem Medicaid |
$7,318.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,598.20
|
| Rate for Payer: Cash Price |
$10,639.88
|
| Rate for Payer: Cigna Commercial |
$17,662.19
|
| Rate for Payer: First Health Commercial |
$20,215.76
|
| Rate for Payer: Humana Commercial |
$18,087.79
|
| Rate for Payer: Humana KY Medicaid |
$7,318.11
|
| Rate for Payer: Kentucky WC Medicaid |
$7,392.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,449.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,704.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,383.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,464.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,726.18
|
| Rate for Payer: Ohio Health Group HMO |
$15,959.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,255.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,766.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,596.72
|
| Rate for Payer: PHCS Commercial |
$20,428.56
|
| Rate for Payer: United Healthcare All Payer |
$18,726.18
|
|
|
MESH PHASIX 20*25CM
|
Facility
|
OP
|
$33,087.79
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,301.41 |
| Max. Negotiated Rate |
$31,764.28 |
| Rate for Payer: Aetna Commercial |
$25,477.60
|
| Rate for Payer: Anthem Medicaid |
$11,378.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,808.48
|
| Rate for Payer: Cash Price |
$16,543.90
|
| Rate for Payer: Cigna Commercial |
$27,462.87
|
| Rate for Payer: First Health Commercial |
$31,433.40
|
| Rate for Payer: Humana Commercial |
$28,124.62
|
| Rate for Payer: Humana KY Medicaid |
$11,378.89
|
| Rate for Payer: Kentucky WC Medicaid |
$11,494.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,131.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,418.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,926.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,607.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,117.26
|
| Rate for Payer: Ohio Health Group HMO |
$24,815.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,617.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,301.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,257.21
|
| Rate for Payer: PHCS Commercial |
$31,764.28
|
| Rate for Payer: United Healthcare All Payer |
$29,117.26
|
|
|
MESH PHASIX 20*25CM
|
Facility
|
IP
|
$33,087.79
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,301.41 |
| Max. Negotiated Rate |
$31,764.28 |
| Rate for Payer: Aetna Commercial |
$25,477.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$25,808.48
|
| Rate for Payer: Cash Price |
$16,543.90
|
| Rate for Payer: Cigna Commercial |
$27,462.87
|
| Rate for Payer: First Health Commercial |
$31,433.40
|
| Rate for Payer: Humana Commercial |
$28,124.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$27,131.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$24,418.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,926.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$29,117.26
|
| Rate for Payer: Ohio Health Group HMO |
$24,815.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,617.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,301.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,257.21
|
| Rate for Payer: PHCS Commercial |
$31,764.28
|
| Rate for Payer: United Healthcare All Payer |
$29,117.26
|
|
|
MESH PHASIX 25*30CM
|
Facility
|
IP
|
$69,568.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,043.84 |
| Max. Negotiated Rate |
$66,785.28 |
| Rate for Payer: Aetna Commercial |
$53,567.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54,263.04
|
| Rate for Payer: Cash Price |
$34,784.00
|
| Rate for Payer: Cigna Commercial |
$57,741.44
|
| Rate for Payer: First Health Commercial |
$66,089.60
|
| Rate for Payer: Humana Commercial |
$59,132.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57,045.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51,341.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,870.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$61,219.84
|
| Rate for Payer: Ohio Health Group HMO |
$52,176.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,913.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,043.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,566.08
|
| Rate for Payer: PHCS Commercial |
$66,785.28
|
| Rate for Payer: United Healthcare All Payer |
$61,219.84
|
|
|
MESH PHASIX 25*30CM
|
Facility
|
OP
|
$69,568.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,043.84 |
| Max. Negotiated Rate |
$66,785.28 |
| Rate for Payer: Aetna Commercial |
$53,567.36
|
| Rate for Payer: Anthem Medicaid |
$23,924.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54,263.04
|
| Rate for Payer: Cash Price |
$34,784.00
|
| Rate for Payer: Cigna Commercial |
$57,741.44
|
| Rate for Payer: First Health Commercial |
$66,089.60
|
| Rate for Payer: Humana Commercial |
$59,132.80
|
| Rate for Payer: Humana KY Medicaid |
$23,924.44
|
| Rate for Payer: Kentucky WC Medicaid |
$24,167.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57,045.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51,341.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20,870.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,404.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$61,219.84
|
| Rate for Payer: Ohio Health Group HMO |
$52,176.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,913.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,043.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,566.08
|
| Rate for Payer: PHCS Commercial |
$66,785.28
|
| Rate for Payer: United Healthcare All Payer |
$61,219.84
|
|
|
MESH PHASIX 4*6 1190200
|
Facility
|
IP
|
$11,330.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
27000073
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,472.90 |
| Max. Negotiated Rate |
$10,876.80 |
| Rate for Payer: Aetna Commercial |
$8,724.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,837.40
|
| Rate for Payer: Cash Price |
$5,665.00
|
| Rate for Payer: Cigna Commercial |
$9,403.90
|
| Rate for Payer: First Health Commercial |
$10,763.50
|
| Rate for Payer: Humana Commercial |
$9,630.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,290.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,361.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,399.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,970.40
|
| Rate for Payer: Ohio Health Group HMO |
$8,497.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,266.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,472.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,512.30
|
| Rate for Payer: PHCS Commercial |
$10,876.80
|
| Rate for Payer: United Healthcare All Payer |
$9,970.40
|
|
